THE X PROCESS:
ANTI-PSYCHIATRY AND ITS HOPES
This essay has three parts. Click here for the second part, “The Facts of Half-life”. Click here for the third part, “No King Lear”.
1. Walter Scott, Ivanhoe (1819; Ware, Herfordshire: Wordsworth Editions, 1995), p. 158.
2. R. D. Laing, The Facts of Life: An Essay in Feelings, Facts, and Fantasy (New York: Pantheon Books, 1976), p. 123.
3. R. D. Laing and A. Esterson, Sanity, Madness and the Family: Families of Schizophrenics (Harmondsworth, Middlesex: Penguin Books, 1970), p. 64.
4. Psychiatry Inside Out: Selected Writings of Franco Basaglia, ed. Nancy Scheper-Hughes and Anne M. Lovell, trans. Anne M. Lovell and Teresa Shtob (New York: Columbia University Press, 1987), p. 195.
5. Anthony Clare, “Anti-Psychiatry: An Alternative View”, New Review, vol. 33, no. 3 (December 1976), 25–30: 30.
6. Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (Garden City, NY: Anchor Books, 1961), p. 165.
7. R. D. Laing, The Divided Self: An Existential Study in Sanity and Madness (Harmondsworth, Middlesex: Penguin Books, 1966), pp. 163, 28, 39, 79.
8. David Cooper, Psychiatry and Anti-Psychiatry (London: Paladin, 1970), p. 109.
9. David Cooper, introduction to Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason, trans. Richard Howard (London: Routledge, 1992), p. vii.
10. R. D. Laing, The Divided Self, p. 40.
11. R. D. Laing and A. Esterson, Sanity, Madness and the Family, pp. 40, 74.
12. Gregory Bateson (ed.), Perceval’s Narrative: A Patient’s Account of His Psychosis, 1830–32 (Stanford, CA: Stanford University Press, 1961), pp. xii, xiv. Originally published in two volumes in 1838 and 1840.
13. R. D. Laing, The Politics of Experience and The Bird of Paradise (London: Penguin Books, 1990), p. 110.
14. R. D. Laing and A. Esterson, Sanity, Madness and the Family, p. 175.
15. R. D. Laing, The Politics of Experience, pp. 99 (italics in original), 103.
16. R. D. Laing, introduction to Morag Coate, Beyond All Reason (London: Constable, 1964), p. ix.
17. R. D. Laing, The Politics of Experience, p. 107.
18. R. D. Laing, The Politics of the Family and Other Essays (New York: Pantheon Books, 1971), p. 51.
This is a slightly revised version of the text first published in New England Review vol. 38, no. 4 (2017), pp. 170–78. © 2017 by Middlebury College Publications.
I
JOURNEYS
JOURNEYS
R. D. Laing started his medical career at Gartnavel Hospital in Glasgow, Scotland, as an enthusiastic innovator. When he came to work in the female refractory ward, nobody treated patients with respect. He asked nurses to instead be friendly with the twelve most hopeless cases, and found that these changes had an immediate effect. The patients who had been dayroom automatons now “hopped and skipped and twiddled around,” delighted by the attention.2 After eighteen months of the new regimen, the twelve of them were discharged. It was, Laing said, one of the most gratifying experiences of his life, and proof that traditional psychiatry could be reformed. Within a year, however, all the women were back in the hospital. (As a patient elsewhere put it, “I did try to start out again in life a couple of years ago and really started to get down to it; but there it is, I got this trouble again.”3) Eventually Laing decided that people couldn’t be helped in asylums, no matter how many enlightened initiatives were attempted. In 1972 he told Franco Basaglia, who successfully led a campaign to shutter Italian asylums, “I had a choice either to stay in the system and try to accomplish what I wanted, without succeeding, or to get out. I got out.”4 What he wanted was an alternative to traditional mental hospitals and orthodox doctors—an anti-psychiatry. Though he came to dislike the name, coined by his friend David Cooper in 1967, it summed up the project well enough.
Anti-psychiatry was born out of anger at the mistreatment of patients who were labeled crazy when what really afflicted them was despair. (Laing said that etymologically “schizophrenia” meant being broken-hearted.) For a few years Laing’s fame and anti-psychiatry’s affinity with the defiant mood of the late Sixties forced the medical profession to reform. Then Laing turned to mysticism while Cooper grew provocatively militant, and anti-psychiatry’s opponents seized the opportunity to discredit the whole project. In 1976 the well-known Irish psychiatrist Anthony Clare spoke for many when he disparaged Laing’s recent work: “It has nothing to offer those to whom Laing appeared to make so many promises, hold out so many hopes.”5 Ungenerous though he was, Clare had a point. The anti-psychiatrists got carried away by the search for solutions to the plight which Laing in particular had a gift for describing, and their interest in suffering faded. For this reason, the problem of hope was more complicated than Clare suggested. There was too much reassurance in Laing’s later work, not too little. Optimism eclipsed the initial pity and dismay. Looking back in a time when the stigma of psychiatric diagnosis has evolved into a badge of social adaptability, or even an identity in itself, it almost seems tragic to have lost anti-psychiatry’s sense of what it is to feel maddeningly cast adrift from other people.
Laing had always been interested in the self’s solitariness and vulnerability, and “alienation” was a watchword in his early work, which was influenced by pessimistic European philosophy and psychoanalysis. Though he admired the influential sociologist Erving Goffman, their views about personal identity differed. Goffman’s Asylums (1961), with its feel for society’s clampdown mechanisms, pictured the self as a war-torn city. “In the hospital,” Goffman wrote, “the inmate can learn that the self is not a fortress, but rather a small open city,” sometimes patrolled by hostile troops and at others by friendly forces.6 Patients discovered how flimsy they were in themselves through the disturbing experience of being invaded by the institution. By contrast Laing believed that many people on wards were remote because they continued to have strong defenses. The “outward behaviour” of the incommunicado patient “is a defensive system analogous to innumerable openings to underground passages which one might imagine would take one to the inner citadel, but they lead nowhere or elsewhere,” he wrote in his first book, The Divided Self (1960). Not only was this self an impregnable fortress but it was surrounded by an ingenious labyrinth. Whereas patients were regarded virtually as nonpersons by traditional psychiatry—the discipline’s founding father Eugen Bleuler was supposed to have said that the mad were “stranger to him than the birds in his garden”—for Laing they were poignantly human in their “separateness and loneliness and despair.” The wartime image he used to describe their suffering wasn’t an open city but a death camp. For such afflicted people, “the world is a prison without bars, a concentration camp without barbed wire.”7 Cooper took up the idea, directly associating asylums with master-race ideology. “The Nazi extermination camps were one product of this Dream of Perfection. The mental hospital,” he wrote in Psychiatry and Anti-Psychiatry (1967), “is another.”8 For Cooper the asylum was also a modern-day Calvary: “There are many available forms of crucifixion in our age; apart from the cross, there are the shock box and the operation of leucotomy, as well as the mass of tranquillizing drugs that flood the ready market of well-trained but gullible psychiatrists.”9 After a while there was no check on the anti-psychiatrists’ outrage at the establishment. Reform became unthinkable.
Laing described the subjective emptiness that troubled him in a ruin of a sentence: “Life, without feeling alive.”10 But he refused to go along with the orthodox psychiatric view that somebody who felt barely alive, or acted so doomed and disconnected as to give that impression, was suffering from a disease that nobody had ever managed to accurately define. Laing and his colleague Aaron Esterson reckoned that a better explanation was to be found in the person’s family background. The studies of eleven female patients in Sanity, Madness and the Family (1964) were drawn from interviews not only with the women but also their closest relatives. A lifelong pattern of maddening communication became apparent. These were families that tied one member in knots, usually by insisting either that she was ill and needed treatment when she didn’t appear to, or that she was fine when she said she felt miserable. What the authors called a spell of make-believe ensnared the women. All their families’ anxiety and resentment bore down on them. The situation was so confusing that more than one of them “mistrusted her own mistrust,” even though it wasn’t misplaced. Another patient likened it all to checkmate: “you can’t make any kind of hopeful move,” she said. “It’s just like a game of chess, you’re absolutely cornered.”11
The concept of double bind, originally formulated by Gregory Bateson and his colleagues in “Toward a Theory of Schizophrenia” (1956), was borrowed by Laing to explain this no-win predicament. But he was too much of a doctor to leave it there. He also took a principle of cure from Bateson, who believed that madness was an extreme kind of meditation rather than a catastrophic failure to think. In 1961 Bateson published an edition of an obscure nineteenth-century memoir, written by the son of an assassinated British prime minister. This man went through what Bateson memorably called a “curative nightmare” in the asylum. That madness’s dark nights of the soul might be healing rather than disastrous was unheard of in psychiatry, but Bateson had done fieldwork as an anthropologist in the South Seas and it gave him another perspective: “a schizophrenic episode would appear to have as definite a course as an initiation ceremony—a death and rebirth,” he wrote, adding that it wasn’t guaranteed that the ritual could always reach the proper conclusion.12 Some people didn’t return from what Bateson called their voyage of discovery, as Laing was well aware. Yet the concept of a dignified, wisdom-seeking journey allowed him to envisage the rejuvenation of deadened lives. “Madness need not be all breakdown,” Laing wrote in The Politics of Experience (1967). “It may also be break-through. It is potentially liberation and renewal as well as enslavement.”13
He imagined a group of planes in flight. The observer on the ground could see that all but one of the aircraft had veered off course, but to the pilots the loner was in the wrong. It was an allegory of the perilous situation that people who became mental patients at some point encountered. In Sanity, Madness and the Family one woman was asked whether she believed it was a good idea to go along with other people’s opinions. “Well if I don’t I usually land up in hospital” was her reply.14 For Laing the only solution for anybody in such a trap was to escape, or else the asylum awaited. “If the formation is itself off course,” he wrote, “then the man who is really to get ‘on course’ must leave the formation” and embark on the solitary path of a psychic explorer venturing into “total inner space and time.”15 Most people knew nothing of this hidden psychic realm. It was the province of visionaries like Friedrich Hölderlin, John Clare, Arthur Rimbaud, Vincent van Gogh, Friedrich Nietzsche, and Antonin Artaud—and it was also the realm where mystics and mental patients saw “spirits, Powers, Thrones, Principalities, Seraphim, Cherubim, The Light.”16 Nowhere more than in families and hospitals, society relentlessly forced its members to be concerned with the outer world at the expense of this inner one. Yet Laing claimed that everybody unconsciously yearned to abandon the normal narrow-minded existence, traverse the self’s depths, and come back transformed. He predicted that future generations would consider as a Dark Age the time when only a few understood that “what we call ‘schizophrenia’ was one of the forms in which, often through quite ordinary people, the light began to break through the cracks in our all-too-closed minds.”17 Repudiating technical language, in The Politics of the Family (1971) Laing gave the inner voyage the bare-bones name of “the X process.” It had a beginning, a middle, and an end, “a movement in, down, back, turning at the nadir, and then out up, forward into the world.”18
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